Health system analysis reveals shift toward less invasive heart valve replacement among younger patients

by Society for Cardiovascular Angiography and Interventions

edited by Robert Egan

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New research simultaneously published in the Journal of the Society for Cardiovascular Angiography & Interventions and presented at TCT 2026 found that the annual number of transcatheter aortic valve replacement (TAVR) procedures among patients younger than 70 increased nearly ninefold within one health system, rising from 15 in 2014 to 134 in 2024. Surgical aortic valve replacement (SAVR) remained the predominant approach across the age groups studied.

The study, "Temporal Trends in Utilization and Early Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Patients Younger Than 70 Years," retrospectively analyzed 5,755 procedures performed across the Baylor Scott & White Health system over 11 years, including 1,008 TAVR procedures and 4,747 SAVR procedures. The increase in TAVR was driven primarily by patients aged 60 to 69, among whom annual volume rose from 14 procedures in 2014 to 121 in 2024. Within the health system, TAVR use among patients younger than 60 remained comparatively limited.

TAVR is a minimally invasive procedure that delivers a replacement valve through a catheter, typically without opening the chest, and generally allows for a shorter recovery than SAVR, which involves open-heart surgery. For younger patients, the treatment decision can be particularly complex because the initial procedure may affect future treatment options. "Among those with substantial anticipated longevity, bioprosthetic valve durability, structural valve deterioration and the potential need for subsequent interventions are central considerations," the authors wrote.

The study also examined early outcomes. Unadjusted rates of acute kidney injury were lower after TAVR than SAVR among patients aged 50 to 59 and 60 to 69. Among patients with available outcome data, acute kidney injury and bleeding after TAVR declined during the study period, while stroke and 30-day mortality did not show significant temporal trends.

"The rapid growth of TAVR among patients in their 60s reflects how treatment options for aortic valve disease are evolving," said Srinivasa Potluri, M.D., FSCAI, co-first author of the study and regional director of cardiology at Baylor Scott & White Health. "For younger patients, the decision extends beyond the initial procedure. Valve durability, the potential need for future interventions and a lifetime treatment strategy should be central to discussions between each patient and the multidisciplinary heart team that helps determine the most appropriate treatment."

The authors cautioned that comparisons between TAVR and SAVR were unadjusted and descriptive. Patients selected for the two procedures had different clinical characteristics, so the findings do not establish that either treatment is superior or equivalent. Because the analysis was conducted within a single health system, the results may not reflect treatment patterns elsewhere.

The study did not evaluate long-term valve durability, reintervention, late stroke, coronary access, surgical explantation or survival. The authors said longer follow-up will be needed to inform lifetime treatment strategies for younger patients.

More information

Srinivasa Potluri et al., Temporal Trends in Utilization and Early Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Patients Younger Than 70 Years, Journal of the Society for Cardiovascular Angiography & Interventions (2026). DOI: 10.1016/j.jscai.2026.105752

Key medical concepts

Transcatheter Aortic Valve ReplacementAcute Kidney InjuryBleeding

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Cardiology Provided by Society for Cardiovascular Angiography and Interventions Who's behind this story?

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